The $84,000 per patient cost for the Sovaldi hepatitis C treatment has caused a national uproar amid an intensifying debate among lawmakers, insurers and economists about the value of expensive medicines to society at large. The dilemma caused by Sovaldi, however, is also forcing state Medicaid programs to make hard choices.

In Illinois, for instance, officials recently instituted a new set of 25 stringent criteria for using Sovaldi, which include treating only those patients with the most advanced stage of liver disease and limiting treatment for those with a history of drug use and alcohol abuse. We spoke with Arvind Goyal, medical director for the Illinois Department of Health Care and Family Services, about the process. This is an edited version.